Prevalence of preserved left ventricular function among patients admitted for pulmonary oedema F.HAZIZA, N.COHEN, J.F.LANDAU, A.C.GUIOMARD. Service de Cardiologie. Hôpital FOCH. Suresnes FRANCE Background: Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). Background: Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left) from those with altered left ventricular function (ALVF). Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). is the first cause of mortality in France, before cancers Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF).Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). Background: Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). Background: Heart failure is the first cause of mortality in France, before cancers. Prevalence, definition and prognosis of diastolic dysfunction is of controversy. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). Background : Heart failure is the first cause of mortality in France, before cancer. Prevalence, definition and prognosis of diastolic dysfunction is controversial. The aim of this study was to evaluate, among a non selected population admitted for pulmonary oedema, the proportion of patients with preserved left ventricular function (PLVF) from those with altered left ventricular function (ALVF). Population and methods : 82 consecutive patients admitted in our department for pulmonary oedema have been retrospectively evaluated. Acute valvular dysfunction and non cardiac causes of dyspnea had been previously excluded. All patients where in NYHA class IV. The echo threshold ejection fraction percentage for definition of preserved left ventricular function was 50%. Left ventricular function was appreciated by Teicholz method in case of homogenous segmental contraction and biplane Simpson in presence of an asymetric segmental contraction, by expert echocardiographist. Clinical, biological, EKG and echocardiographic parameters were also analysed and compared regarding the two subgroups (PLVF vs ALVF) Statistics : Comparaison between groups was performed using t student test or Chi-2 as appropriate. P<0.05 was considered significant Results : Detailed results are summarised in Table 1 Sex ratio was 35 women and 47 men. Three was no sex difference between the two subgroups 84% (n=69) of echocardiograms were performed during the first 72 hours 11%(n=9) were made after 72 hours but were enrolled as altered left ventricular function 5% (n=4) were enrolled as preserved left ventricular function on the basis of Vasan and Levy classification (1) and Gandhi study (2) Among 82 patients: 46% (N=38) had a PLVF vs 54% (N=44) had an ALVF (Figure 1) Prevalence of PLVF was high, mainly among the oldest population (Figure 2,3,4). Figure 1 Proportion of PLVF vs ALVF Figure 2. Extreme ages and EF Average age for patients with PLVF vs ALVF was 78 years old vs 71 (p=0.0064) 70% of patients above 80 years of age had PLVF Patients with PLVF had a higher systolic blood pressure: 155 mmhg vs 136 mmhg (p=0.01) and also a significant higher pulsed pressure: 69 mmhg vs 53 mmhg (p=0.003). Age matched, there was no more difference between the two subgroups. Diastolic blood pressure was equal among the two subgroups. Systolic and diastolic echo diameters were correlated to the left ventricular function with a clear tendency towards dilated diameters in the ALVF subgroup (p<0.0001) Figure 3. Age and EF EF : Ejection fraction. BMI : Mass index SBP : systolic blood pressure DBP : diastolic blood pressure EDD : end diastolic diameter ESD: end systolic diameter. PP : pulsed pressure AF : Atrial fibrillation. Sokolov : SV1+RV5 or SV2+RV6. HR : heart rate. Table 1 Figure 4. Age distribution when EF>50% Discussion : Because of its complex hemodynamic definition we used the term of preserved ventricular function instead of diastolic dysfunction. Lack of consensus among diastolic echographic parameters led us to use only the systolic approach.(3) The fact that PLVF was more frequent in the elderly population is consistent with recent publications (4) and underline the usual under estimation of this entity. The border is around 75 years in our study. Before 75, proportion of ALVF is prominent. After 75, PLVF is prominent. Increased vascular stiffness and decrease of left ventricule distensibility are essential aspects of cardiovascular aging and may explain our results. In our study, pulsed pressure and systolic blood pressure were correlated to PLVF. After age adjustement, pulsed pressure pressure wasn’t.. It underlines the major role of vascular resistance and cardiovascular aging in pulmonary oedema genesis when left ventricular function is preserved. Further prospective studies are needed to confirm these results. Conclusion: Almost half of the patients admitted for pulmonary oedema have a preserved left ventricular function (EF>50%) They are older, have a higher systolic blood pressure and a higher pulsed pressure. These parameters seem related to age rather than to a specific cardiac pathology. Their echocardiographic left ventricular diameters are significantly lower. Those results confirm the prominent role of age in the alteration of the cardiovascular system, and one of its most relevant clinical consequence that consists in pulmonary oedema. 1-R S Vasan J Am Coll Cardiol 1995:26: Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. 2-S.K.Gandhi, N Eng J Med 2001;344: The pathogenesis of acute pulmonary edema associated with hypertension. 3-M C Petrie, Heart 2004;90: Poor concordance of commonly used echocardiographic measures of left venricule diastolic function in patients with suspected heart failure but preserved systolic function: is there a reliable echocardiographic measure of diastolic dysfunction 4-J.G.F.Cleland, Eur Heart J 2003; 24: The Euro Heart Failure survey programme. EF< 50%(n=44) ALVF EF>50%(n=38) PLVF p Age Sex ratio (M,F)26/1820/180.5 Diabetes7/40 (18%)10/38 (26%)0.3 Known hypertension25/40 (63%)28/37 (76%)0.2 Clearance Creat (ml/mn) BMI (kg/m2) SBP (mm Hg) DBP (mm Hg) PP (mm Hg) Heart rate AF, Flutter16/43 (37%)11/38 (29%)0.4 Sokolov (mm) Troponin I (µg/l) EDD (mm) < ESD (mm)4833<0.0001